Impact Of Medical Therapy Research Articles

Application of Quantitative Assessment of Coronary Atherosclerosis by Coronary Computed Tomographic Angiography.

Coronary computed tomography angiography (CCTA) has emerged as a pivotal tool for diagnosing and risk-stratifying patients with suspected coronary artery disease (CAD). Recent advancements in image analysis and artificial intelligence (AI) techniques have enabled the comprehensive quantitative analysis of coronary atherosclerosis. Fully quantitative assessments of coronary stenosis and lumen attenuation have improved the accuracy of assessing stenosis severity and predicting hemodynamically significant lesions. In addition to stenosis evaluation, quantitative plaque analysis plays a crucial role in predicting and monitoring CAD progression. Studies have demonstrated that the quantitative assessment of plaque subtypes based on CT attenuation provides a nuanced understanding of plaque characteristics and their association with cardiovascular events. Quantitative analysis of serial CCTA scans offers a unique perspective on the impact of medical therapies on plaque modification. However, challenges such as time-intensive analyses and variability in software platforms still need to be addressed for broader clinical implementation. The paradigm of CCTA has shifted towards comprehensive quantitative plaque analysis facilitated by technological advancements. As these methods continue to evolve, their integration into routine clinical practice has the potential to enhance risk assessment and guide individualized patient management. This article reviews the evolving landscape of quantitative plaque analysis in CCTA and explores its applications and limitations.

The impact of medical therapy on left ventricular strain: Current state and future perspectives.

The speckle tracking strain is becoming a frequently used marker of subclinical left ventricular systolic dysfunction. Despite the wide range of data concerning left ventricular strain variability in the general population and its changes in various pathologic conditions, the information about the impact of medical therapy on left ventricle strain is limited. This article provides an analysis of published studies of left ventricle strain changes in response to different agents and combinations of medical therapies used for hypertension and congestive heart failure.

The effects of medications for treating COPD and allied conditions on stroke: a population-based cohort study

Patients with chronic obstructive pulmonary disease (COPD) are at higher risk of stroke. This study aimed to investigate the clinical factors of stroke risk in COPD and allied conditions patients and associations between medications for treating COPD and allied conditions. The population-based study cohort comprised 24,173 patients diagnosed with COPD and allied conditions between 2000 and 2013, and 24,170 selected matched patients without COPD comprised the comparison cohort from a nationwide database. Cox-proportional hazard regression was performed to determine the impact of medical therapies, comorbidities, and other clinical factors on stroke risk. Of the 48,343 included patients, 1394 (2.9%) experienced stroke during follow-up, with a significant difference between COPD and allied conditions cohort (1003/4.2%) and comparison cohort (391/1.6%) (adjusted hazard ratio [aHR]: 2.72, p < 0.001). Cox-regression analysis revealed that COPD and allied conditions patients who were older (>65 years) (HR: 1.06); male (HR: 1.39); with hypertension (HR: 1.46), diabetes mellitus (HR: 1.33) and atrial fibrillation (HR: 1.63) had increased stroke risk. Mucolytics (HR: 0.44) and combination therapy with inhaled corticosteroids (ICS) and long-acting β2-agonists (LABA) (HR: 0.75) were associated with decreased stroke risk in COPD and allied conditions patients. Among COPD and allied conditions patients, major comorbidities increase risk of stroke. Therapy with mucolytic agents and combination ICS/LABA is associated with risk reduction.

PULMONARY ARTERIAL HYPERTENSION AND INTRADUCTAL PAPILLARY MUCINOUS NEOPLASMS: A NOVEL ASSOCIATION?

PULMONARY ARTERIAL HYPERTENSION AND INTRADUCTAL PAPILLARY MUCINOUS NEOPLASMS: A NOVEL ASSOCIATION?

The impact of medical therapies and factors related to treatment procedures in women with rheumatoid arthritis and inflammatory bowel disease receiving assisted reproduction: a nationwide cohort study

To examine whether medications used to treat rheumatoid arthritis (RA)/chronic inflammatory bowel disease (IBD), or factors related to the assisted reproductive technology (ART) procedures, impact the success of ART. In women with RA/IBD, initial studies have shown a reduced chance of a live-born child after ART. Cohort study. Nationwide Danish health registries. All Danish women with a fresh embryo transfer from January 1, 2006, through 2018. The cohorts comprised 1,824 embryo transfers in women with RA/IBD and 97,191 embryo transfers in women without RA/IBD. Observational, noninterventional study. Live birth per fresh embryo transfer. The chance of a live birth in women with RA/IBD receiving ART, compared with other women receiving ART, had an adjusted odds ratio (OR) of 0.79 (95% confidence interval [CI], 0.68-0.91). Prescribed corticosteroids before embryo transfer were positively associated with a live-born child (adjusted OR, 1.21; 95% CI, 1.12-1.31), while the use of antiinflammatory/immunosuppressive agents did not have significant importance. Intracytoplasmic sperm injection was associated with a reduced chance (adjusted OR, 0.94; 95% CI, 0.90-0.97). Type of hormone treatment protocol did not have significant importance, and transfer at the blastocyst stage was positively associated with a live-born child (adjusted OR, 1.54; 95% CI, 1.46-1.62). In women with RA and/or IBD, prescribed corticosteroid before embryo transfer and embryo transfer at the blastocyst stage were associated with successful ART. Intracytoplasmic sperm injection was associated with a slightly reduced chance. Antiinflammatory/immunosuppressive agents and type of hormone protocols did not have significant importance.

The impact of medical therapy for benign prostatic obstruction on the health-related quality of life at tertiary hospital: A prospective study

Benign prostatic obstruction (BPO) is a common condition in older men that often result in lower urinary tract symptoms (LUTS). LUTS associated with Benign Prostate Enlargement (BPE) may have significant negative impact on patients’ health-related quality of life as can certain treatments for the condition. This study aimed to determine the impact of medical therapy on health-related quality of life among patients on treatment for BPO.This was a hospital based descriptive study carried out in urology public and private clinics from April to December 2017. All diagnostic and treatment options of patients were decided by attending clinicians of which Patients aged ≥40 years on medical treatment for BPO were included. Symptom and Health Related Quality Life (HRQL) were measured at baseline and at 3 months using the International Prostate Symptom Score (IPSS) and the Benign Prostatic Hyperplasia Impact Index score (BII) tools. A total 150 patients were included in the analysis with a mean age of 54), mean PSA of 4.45ng/ml and a mean prostate volume 54.62cc. Majority, 144(96.5%) had moderate and severe LUTS and 94(63%) men received a combination of tamsulosin and finasteride and 44(29%) men received tamsulosin alone: Medical therapy was associated with overall improvement of quality of life (p&lt;0.001). A combination of tamsulosin and finasteride was associated with more adverse effects. Improvements in Quality of life (QoL) and symptoms were noted across the medical treatments most widely used in real-life practice at MNH to manage patients with BPO. Tamsulosin showed an equivalent efficacy to a combination of tamsulosin and finasteride at third month of therapy with fewer adverse effects.

Associations between seizure severity change and patient characteristics, changes in seizure frequency, and health-related quality of life in patients with focal seizures treated with adjunctive eslicarbazepine acetate: Post hoc analyses of clinical trial results

The relationships between seizure severity change and patient characteristics, changes in seizure frequency, and health-related quality of life (HRQoL) may be important for determining the overall impact of medication therapy on patients with epilepsy. The objectives of these post hoc analyses of the global Phase III 093-0304 trial (NCT00988429, Study 304) of adjunctive eslicarbazepine acetate (ESL) in patients with refractory focal (partial-onset) seizures (FS) were to evaluate associations between seizure severity change, measured by the Seizure Severity Questionnaire (SSQ), and 1) patient characteristics, 2) seizure frequency change, standardized as the seizure frequency (SSF) per 28-day period, and 3) change in HRQoL, evaluated by the Quality of Life in Epilepsy Inventory-31 (QOLIE-31) and the Montgomery–Åsberg Depression Rating Scale (MADRS).The analyses were conducted on the per-protocol population (PPP) of patients who were randomized to a placebo arm (n = 188) or an ESL-active group that included treatment with adjunctive ESL 800 mg once daily (QD; n = 184) or adjunctive ESL 1200 mg QD (n = 175). General linear models (GLM) were used to measure the association between SSQ change and patient baseline characteristics or percentage change in the SSF from baseline. Associations between changes in the SSQ and changes in the QOLIE-31 and MADRS were examined using GLM with patient baseline characteristics as covariates. Subgroup analyses were performed for patients in the ESL-active group and those treated with ESL 800 mg or ESL 1200 mg. Minimal clinically important difference (MCIDs) thresholds were used to assess improvements in SSQ scores.The analyses included 547 per-protocol patients. Patients using 1 antiepileptic drug (AED) at baseline had greater improvements in the SSQ compared with those receiving 2 AEDs (P = 0.0606). Treatment with ESL 1200 mg was significantly associated with clinically meaningful improvements in the SSQ (P = 0.0005). The SSQ improvements were significantly associated with an SSF reduction of ≥75%, compared with no reduction (P < 0.0001). In the PPP and the ESL-active group, SSQ improvements were significantly associated with improvements in QOLIE-31 Total Score (TS; P < 0.0001) and the Seizure Worry (SW; P < 0.0001) and Social Functioning (SF; P = 0.0030) subscales. In the ESL 1200 mg subgroup, SSQ improvements were significantly associated with improvements in QOLIE-31 TS (P < 0.0001) and the SW (P < 0.0001) and Energy/Fatigue (EF; P = 0.0007) subscales. In the ESL 800 mg subgroup, improvements in the SSQ were significantly associated with improvements in QOLIE-31 TS (P = 0.0362) and the SW (P = 0.0241) subscale. There was no significant association between changes in the SSQ and changes in the MADRS in patients treated with ESL.These findings demonstrated that in this clinical trial population, adding ESL to baseline AED therapy had utility for decreasing seizure severity and improving HRQoL. There were no significant associations between changes in seizure severity and changes in depressive symptoms in patients with FS.

Impact of Medical Therapy on Late Morbidity and Mortality After Aortic Aneurysm Repair for Aortitis

Patients with active aortitis who undergo repair of ascending aortic aneurysms have an increased risk of late reoperation and decreased late survival. We aimed to determine the reasons for these poor outcomes and the influence of medical management. We reviewed records of 186 patients (median age 73.9 years; 120 women) with noninfectious aortitis after elective ascending aortic aneurysm repair (January 1955 through December 2012). Landmark analysis was used to compare outcomes in patients with isolated aortitis versus with systemic sequelae of aortitis along with outcomes of treatment with glucocorticoids. At 15 years, the overall mortality was 88.3%; at 10 years, the overall reoperation rate was 28.2%. Long-term mortality increased with older age at surgery (hazard ratio [HR] 1.62, 95% confidence interval [CI]: 1.25 to 2.11, p < 0.001), coronary artery disease (HR 1.94, 95% CI: 1.25 to 3.01, p= 0.003), peripheral vascular disease (HR 1.79, 95% CI: 1.09 to 2.94, p= 0.02), and preoperative suspicion of aortitis (HR 4.90, 95% CI: 1.96 to 12.26, p < 0.001). Increased reoperation rate was associated with coronary artery disease (HR 2.69, 95% CI: 1.17 to 6.17, p= 0.02) and peripheral vascular disease (HR 3.92, 95% CI: 1.71 to 8.94, p= 0.001). Among patients free of reoperation at 6 months, systemic sequelae of aortitis were found to be significant, with an unadjusted hazard ratio of 3.59 (95% CI: 1.40 to 9.18, p= 0.008). Treatment with glucocorticoids was not associated with subsequent mortality or reoperation. The development of systemic illness secondary to aortitis was associated with increased risk of late aortic reoperations. However, glucocorticoid treatment of noninfectious aortitis did not clearly influence survival or need for reoperation.

Su1415 Impact of Medical Therapies on the Natural History in Ulcerative Colitis. an 8-Year Follow-Up of a Cohort Study From a Tertiary Center

Su1415 Impact of Medical Therapies on the Natural History in Ulcerative Colitis. an 8-Year Follow-Up of a Cohort Study From a Tertiary Center

Recovery of Echocardiographic Function in Children With Idiopathic Dilated Cardiomyopathy: Results From the Pediatric Cardiomyopathy Registry

This study sought to determine the incidence and predictors of recovery of normal echocardiographic function among children with idiopathic dilated cardiomyopathy (DCM). Most children with idiopathic DCM have poor outcomes; however, some improve. We studied children <18 years of age from the Pediatric Cardiomyopathy Registry who had both depressed left ventricular (LV) function (fractional shortening or ejection fraction z-score <-2) and LV dilation (end-diastolic dimension [LVEDD] z-score >2) at diagnosis and who had at least 1 follow-up echocardiogram 30 days to 2 years from the initial echocardiogram. We estimated the cumulative incidence and predictors of normalization. Among 868 children who met the inclusion criteria, 741 (85%) had both echocardiograms. At 2 years, 22% had recovered normal LV function and size; 51% had died or undergone heart transplantation (median, 3.2 months), and 27% had persistently abnormal echocardiograms. Younger age (hazard ratio [HR]: 0.92; 95% confidence interval [CI]: 0.88 to 0.97) and lower LVEDD z-score (HR: 0.78; 95% CI: 0.70 to 0.87) independently predicted normalization. Nine children (9%) with normal LV function and size within 2 years of diagnosis later underwent heart transplantation or died. Despite marked LV dilation and depressed function initially, children with idiopathic DCM can recover normal LV size and function, particularly those younger and with less LV dilation at diagnosis. Investigations related to predictors of recovery, such as genetic associations, serum markers, and the impact of medical therapy or ventricular unloading with assist devices are important next steps. Longer follow-up after normalization is warranted as cardiac failure can recur. (Pediatric Cardiomyopathy Registry; NCT00005391).

P457 Impact of medical therapies on the natural history in ulcerative colitis. An 8-year follow-up of a cohort study from a tertiary center

P457 Impact of medical therapies on the natural history in ulcerative colitis. An 8-year follow-up of a cohort study from a tertiary center

518 Impact of medical therapy on transurethral resection of the prostate (TURP): Two decades of change

518 Impact of medical therapy on transurethral resection of the prostate (TURP): Two decades of change

Long-Term Effects of Doxazosin, Finasteride and Combination Therapy on Quality of Life in Men with Benign Prostatic Hyperplasia

We examined the effects of doxazosin, finasteride and combination therapy among men with benign prostatic hyperplasia on quality of life assessed with MOS-SF-36 (Medical Outcomes Study Short-Form 36) and 2 disease specific instruments (BII, benign prostatic hyperplasia Impact Index and I-PSS-QoL, International Prostate Symptom Score-QoL) during 4 years. The MTOPS (Medical Therapy of Prostatic Symptoms) study was a multicenter, randomized, double-blind, placebo controlled clinical trial with a primary outcome of time to benign prostatic hyperplasia progression. Change in quality of life was a secondary outcome. A total of 2,872 men enrolled in the MTOPS study who had 3 baseline quality of life measures and at least 1 followup measure by any of the quality of life instruments were analyzed. Compared with men assigned to placebo, men assigned to doxazosin and combination experienced a statistically significant improvement in the BII at year 4. Men assigned to each of the drug groups also experienced a significant improvement in the I-PSS-QoL compared with those assigned to placebo. Considering longitudinal changes during 4 years, a significant improvement in BII and I-PSS-QoL scores was observed in men assigned to the drug groups compared with those assigned to placebo. However, there were no significant differences for the MOS-SF-36 subscales and summary scores when drug groups were compared with the placebo group. The quality of life of men treated with doxazosin, finasteride, and the drugs combined generally improved when assessed with the BII and the I-PSS-QoL compared with those treated with placebo. Quality of life did not show improvement when measured by the MOS-SF-36.

Current imaging modalities for atherosclerosis

Atherosclerotic disease is responsible for nearly half of all deaths in the western world. During the past three decades, considerable efforts have been made towards detection and assessment of atherosclerosis plaques in various vascular beds using different imaging techniques. Recently, both noninvasive and invasive modalities have frequently been used to refine cardiovascular risk assessment in high-risk individuals, to evaluate the natural history of atheroma burden and to reveal the impact of anti-atherosclerotic medical therapies on disease progression. In this review, we provide an overview of the currently available imaging modalities. This article will underscore arterial wall imaging to assess the impact of medical therapies on atherosclerosis and to develop the effective therapeutic strategies, resulting in the prevention of cardiovascular complications.

Impact of medical therapies on inflammatory bowel disease complication rate

Crohn's disease and ulcerative colitis are progressive diseases associated with a high risk of complications over time including strictures, fistulae, perianal complications, surgery, and colorectal cancer. Changing the natural history and avoiding evolution to a disabling disease should be the main goal of treatment. In recent studies, mucosal healing has been associated with longer-term remission and fewer complications. Conventional therapies with immunosuppressive drugs are able to induce mucosal healing in a minority of cases but their impact on disease progression appears modest. Higher rates of mucosal healing can be achieved with anti-tumor necrosis factor therapies that reduce the risk of relapse, surgery and hospitalization, and are associated with perianal fistulae closure. These drugs might be able to change the natural history of the disease mainly when introduced early in the course of the disease. Treatment strategy in inflammatory bowel diseases should thus be tailored according to the risk that each patient could develop disabling disease.

Prevention and Treatment of Postproctectomy Infertility

Physicians who care for patients of childbearing potential of both genders who require pelvic surgery must have a clear understanding of the best-available evidence with regards to infertility as an outcome in this cohort. More specifically, colorectal surgeons must clearly understand the ramifications of altered anatomy on fertility and be able to adequately counsel patients. In this article we provide definitions associated with fertility and review the best-available literature regarding the impact of medical therapy for inflammatory bowel disease on fertility and both female and male infertility after proctectomy for chronic ulcerative colitis and rectal cancer. Finally, we review techniques for optimization of fertility as well as available options and treatments for those who have difficulty conceiving.

Abstract P59: Impact of Drug Therapy on Refractory Angina

Background: Revascularization is the ultimate therapeutic option for symptomatic angina patients on medical therapy. However, a continuously growing patient population presents with angiographic features not (any more) amenable to revascularization (refractory angina). The impact of medical therapy in refractory angina patients has not been evaluated. We sought to determine the symptom control in ‘spontaneous’ clinical practice and how this is affected by strict implementation of current guidelines for the management of chronic angina. Methods: Patients diagnosed with chronic stable angina who were not candidates for revascularization were included. Drug therapy over the last 4 weeks was recorded and patients were administered the Seattle Angina Questionnaire (SAQ). A 3 week period of drug insertion and/or titration was allowed. All patients were re-evaluated and repeated the SAQ at 6 months. Friedman's test with Bonferroni correction was used to compare difference in angina among the groups. A p value &lt;0.05 was considered statistically significant. Results: A total of 118 patients were included (mean age 72 years; 71% males). Sixty-eight percent of patients were on beta-blockers (BB) (only 40% on maximally tolerated dose), 41% on calcium channel blockers (CCB), 81% on nitrates and 89% on aspirin. According to SAQ, 36% of patients suffered 3 or more angina episodes per week and 19% had heavy limitations in daily activities. At 6 months, 77% of patients were on maximally tolerated BB dose, 44% on CCB, 82% on nitrates and 93% on aspirin. SAQ score results improved significantly, with 20% of patients showing clinically important differences. Twenty-four percent of patients reported 3 or more angina episodes per week and 15% had heavy daily limitations. Conclusions: Refractory angina patients have a poor quality of life and often are not prescribed maximally tolerated drug therapy. Optimization of treatment regimen significantly improves quality of life but is clearly not sufficient for symptom control. Strategies for the treatment of this patient population are needed to be evaluate in clinical trials.

Defibrillators and Cardiac Resynchronization Therapy as a Bridge to Cardiac Transplantation

Despite the positive impact of medical therapy, the burden of heart failure persists, with disease progression, frequent hospitalizations, and reduced survival. Mortality related to ventricular tachyarrhythmias and/or pump failure has led to the introduction of device therapy. Implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT) have now been established as the standard of care in selected patients with chronic heart failure. CRT and ICDs offer the opportunity to reduce morbidity and increase survival in patients with drug-refractory heart failure, and to retard, if not prevent, development of end-stage heart failure requiring cardiac transplantation.

Impact of medical therapy on transurethral resection of the prostate: two decades of change

• To examine how the introduction of medical therapy for symptomatic benign prostatic hyperplasia (BPH) might have changed the indications, patient characteristics and outcomes in men undergoing transurethral resection of the prostate (TURP) over two decades (1988-2008). • All patients who underwent TURP for symptomatic BPH in a geographically defined area at our institution in 1988 (before the introduction of medical therapy for BPH), 1998 (when medical therapy was becoming an important therapy for BPH), and 2008 (when medical therapy was the primary first line therapy for BPH) were reviewed. • We assessed the total number of TURPs, indications for surgery, patient age, health status, weight of resected tissue, and pre- and postoperative events/complications. • There was a 60% decrease in TURPs from 1988 to 1998 with a moderate increase in number in 2008. • Failure of medical therapy was not an indication for TURP in 1988, but was at least one of the indications in 36% and 87% of patients in 1998 and 2008, respectively. • There was a substantial rise in the percentage of patients (but not total number or percentage of men at risk for BPH) presenting with acute or chronic urinary retention (AUR or CUR) at the time of their TURP (from 22.9% in 1988 to 42.9% in 2008, and from 14.6% in 1988 to 39.3% in 2008 for AUR and CUR, respectively). There was also a rise in the percentage of patients presenting with preoperative hydronephrosis (1.3% in 1988, 12.5% in 1998, 7.1% in 2008). • Inpatient stays decreased (from 4.1 day in 1988 to 2.7 days in 1998, and to 2.1 day in 2008), but the number of patients discharged with a catheter increased over the two decades (from 3.2% in 1988 to 12.5% in 1998, and to 28.6% in 2008). • The increasing use of medical therapy as a first line treatment for BPH has resulted in a dramatic decrease in TURPs which, in turn, has been associated with an apparent increase in risk of poor pre- and postoperative outcomes. However, the actual number (either the total number or as a percentage of men at risk for BPH) who have experienced these progression events has not changed and the postoperative outcomes are probably related to earlier catheter removal and hospital discharge. • It appears that we are performing TURP on the right patients.

Intracoronary Ultrasound in Assessing Efficacy of Cardiovascular Drugs

Despite substantial advances in our approach to prevent cardiovascular disease, there is an ongoing need to develop new therapeutic strategies to achieve more effective reduction in cardiovascular risk. Intravascular ultrasound imaging of the coronary arteries has been increasingly employed in clinical trials to evaluate the impact of medical therapies on the progression of atherosclerosis. In addition to the ability to assess whether novel agents can slow disease progression, these studies have provided a number of important insights into the factors that underlie the natural history of disease progression.